Clinical Anatomy of Jaundice II

Question 1

Describe the different ducts that form the biliary tree.

Answer 1

The biliary tree is made up of: Right and left hepatic ducts unite to form the common hepatic duct Common hepatic duct unites with the cystic duct to form the bile duct

Question 2

What is the function of the biliary tree?

Answer 2

The biliary tree is responsible for transporting bile

Question 3

State the four parts of the duodenum and their relationship with peritoneum

Answer 3

Superior (part intraperitoneal) Descending (retroperitoneal) Horizontal (retroperitoneal) Ascending (retroperitoneal)

Question 4

Where does the duodenum begin and end?

Answer 4

Begins at the pyloric sphincter Ends at the duodenal-jejunal flexure

Question 5

What hormones does the duodenum secrete into the blood?

Answer 5

Peptide hormones (gastrin and CCK)

Question 6

Name the different parts of the pancreas

Answer 6

Head (with uncinate process) Neck Body Tail

Question 7

State the different anatomical relationships of the pancreas

Answer 7

Right kidney, left kidney, IVC, bile duct, abdominal aorta and superior mesenteric vessels all lie posterior Stomach lies anterior Splenic vessels lie superoposteriorly Duodenum surrounds the head

Question 8

Name the organs shown in this picture

Answer 8

1) Right kidney
2) Liver
3) Pancreas
4) Abdominal aorta
5) Stomach
6) Left kidney
7) Spleen

Question 9

State the different functions of the pancreas

Answer 9

Exocrine - acinar cells dump their enzymes into the pancreatic duct

Endocrine - islets of Langerhans dump their hormones into the blood

Question 10

Describe the anatomy of the bile duct

Answer 10

The bile duct descends posteriorly to the first part of the duodenum

It then travels into a groove on the posterior aspect of the pancreas and joins with the main pancreatic duct - forms the ampulla of Vater

Question 11

Describe the process of carrying out endoscopic retrograde cholangiopancreatography (ERCP)

Answer 11

Endoscope inserted into the duodenum via the oral cavity

Cannula placed into major duodenal papilla and radio-opaque dye injected back into biliary tree

Radiographic images are taken

Question 12

List some causes of jaundice

Answer 12

Gallstones - cause blockage of bile back to liver causing overspill into blood

Carcinoma at head of pancreas

Extrahepatic causes

Question 13

State the arteries that supply the duodenum and pancreas

Answer 13

Gastroduodenal artery (branch of common hepatic artery)

Splenic artery

Dorsal pancreatic artery

Superior mesenteric artery

Superior & inferior pancreaticoduodenal arteries (anastomose)

Question 14

Explain the cause and presentation of pancreatic pain

Answer 14

Pancreatic pain is secondary to pancreatitis - often caused by blockage of the ampulla causing bile to be diverted into the pancreas

The pancreas is a foregut & midgut organ meaning pain can present in the epigastric and/or umbilical region

Question 15

Describe the different signs of acute pancreatitis

Answer 15

Grey-Turner’s sign - blue bruising around the flanks

Cullen’s sign - blue bruising around umbilicus

Question 16

State the main differences between the jejunum and the ileum

Answer 16

Jejunum is deep red in colour while ileum is lighter pink

Jejunum has a thicker/heavier wall

Jejunum is more vascular

Jejunum has less mesenteric fat

Jejunum has large, tall and closely pack folds while ileum has low and sparse folds

Ileum has lymphoid tissue in Peyer’s patches, jejunum has no lymphoid tissue

Question 17

State the blood supply of the jejunum and ileum

Answer 17

Jejunum and ileum are supplied arterial blood from the superior mesenteric artery via jejunal and ileal arteries

Jejunum and ileum are drained by jejunual and ileal veins to superior mesenteric vein to hepatic portal vein

Question 18

Describe the anatomy of the superior mesenteric artery

Answer 18

The SMA leaves the aorta at L1 and runs posterior to the neck of the pancreas. It travels in an inferior direction, anterior to the uncinate proccess of the pancreas before entering the mesentery proper

Question 19

State where fat is absorbed to

Answer 19

Fat is absorbed into intestinal cells (with help of bile). It is passed to lacteals (specialised lymphatic vessels) before traveling via the lymphatic system. The fat then drains into the venous system at the left venous angle

Question 20

Describe the lymphatics of the abdomen

Answer 20

Lymph vessels tend to run alongside their associated abdominal arteries

The lymph nodes draining abdominal organs include:

Coeliac - drains foregut

Superior mesenteric - drains midgut

Inferior mesenteric - drains hindgut

Lumbar - drains kidneys. pelvis and lower limbs